2.3. Summarise the history of public health

This guide will help you answer 2.3. Summarise the history of public health.

Public health focuses on improving health, preventing illness, and prolonging life in a population through collective efforts. Its history shows how societies have worked to address diseases and promote wellbeing. This outlines the history of public health, focusing on how these developments have influenced modern practices.

Early Societies and Public Health

In ancient times, public health was mainly a response to visible problems like poor sanitation or disease outbreaks. People recognised the link between cleanliness and health, even though they didn’t understand the science behind it.

Early examples of public health include:

• Ancient Egyptians: They used basic hygiene practices such as bathing and sewage systems to prevent diseases.
• The Greeks (500–300 BC): They believed in healthy living, focusing on exercise, diet, and clean environments. Hippocrates, known as the “Father of Medicine,” suggested that environmental factors, such as water and air quality, influenced health.
• Romans (27 BC–476 AD): Romans built aqueducts, public baths, and sewer systems to supply clean water and remove waste. These achievements improved sanitation and reduced illnesses in their cities.

Although people knew how to reduce risk, they lacked accurate understanding of how diseases spread. Concepts of bacteria and viruses were yet to be discovered.

The Middle Ages: Decline in Public Health

After the fall of the Roman Empire, public health practices in Europe declined. Sanitation systems were abandoned, and many lived in overcrowded and dirty environments. This lack of hygiene allowed diseases to spread rapidly.

Key public health problems during this time:

• Plagues, including the Black Death (1347–1351), killed millions across Europe. People didn’t know the cause, but they identified the importance of quarantine to control the spread of illness.
• Overcrowded towns increased the risk of infection from poor water supplies and waste management.

Some religious institutions provided healthcare by running hospitals, but these mainly dealt with symptoms rather than prevention.

The Renaissance: Changing Views on Health

The Renaissance (14th–17th century) was a period of renewed interest in science and the human body. Scientific discoveries began to shift health understanding. Scholars observed patterns and explored new ways to improve health.

Achievements during this period included:

• Improved knowledge of anatomy and diseases through studies such as autopsies.
• Early public health measures like quarantine laws to control outbreaks of diseases.

Despite these advances, sanitation and disease control remained major problems across Europe during this time.

The Industrial Revolution: Birth of Modern Public Health

The Industrial Revolution (18th–19th century) transformed societies. Rapid industrialisation and urbanisation led to overcrowding in cities, poor living conditions, and increased disease outbreaks. For the first time, governments recognised that public health needed organised management.

Key milestones during this period:

• Edwin Chadwick’s 1842 report, “The Sanitary Condition of the Labouring Population,” showed how poor sanitary conditions caused disease and recommended reforms.
• John Snow’s 1854 investigation into a cholera outbreak in London demonstrated that the disease spread through contaminated water. This was a major step towards recognising waterborne diseases.

Acts Introduced for Public Health:

• The Public Health Act (1848): The government took responsibility for sanitation, sewerage systems, and safe water supplies.
• The Factory Acts: These regulated working conditions, including safety for labourers, which helped prevent injuries and improve worker health.

The industrial era laid the foundation for modern public health. It emphasised the importance of sanitation, clean water, and governmental responsibility in protecting populations.

The Germ Theory: A New Medical Understanding

Before the 19th century, most health problems were attributed to “miasma,” or bad air. However, the discovery of “germ theory” revolutionised medical and public health systems.

Key figures in germ theory development:

• Louis Pasteur (1860s): He proved that microorganisms cause diseases and developed pasteurisation to kill harmful bacteria in food and drink.
• Robert Koch (1870s): He identified specific bacteria that caused diseases like tuberculosis and cholera.

This understanding shifted focus to preventing the spread of microorganisms. Hygiene practices improved as people became aware of the need to sterilise medical tools and maintain clean environments.

The Rise of Vaccination

Edward Jenner’s discovery of the smallpox vaccine in 1796 laid the groundwork for immunisation. Vaccines became an essential tool in public health, helping prevent diseases like measles, tuberculosis, and polio.

Key moments in vaccination history:

• By the late 19th century, vaccination programmes were widely adopted.
• The eradication of smallpox in 1980 was a landmark success for global public health.

The development of vaccines saved millions of lives and made disease prevention a priority in healthcare systems.

20th-Century Developments

The 20th century saw rapid improvements in public health. Science, technology, and global cooperation created stronger systems to deal with health issues.

Public health efforts included:

• Expansion of healthcare services: The UK established the National Health Service (NHS) in 1948 to offer free healthcare to all citizens.
• Advances in antibiotic treatments, like penicillin (discovered by Alexander Fleming in 1928), significantly reduced death rates from infectious diseases.
• Health education campaigns taught people how to adopt healthier lifestyles through diet, exercise, and avoiding smoking.

Public health shifted focus to reducing chronic diseases like cancer, heart disease, and diabetes through preventive measures rather than only treating illnesses.

Global Health Problems

Public health became a global issue in the 20th century. International organisations, such as the World Health Organization (WHO), formed to coordinate global efforts.

Examples of global public health milestones include:

• Eradication of diseases such as smallpox through vaccination.
• Efforts to control pandemics like HIV/AIDS and COVID-19.
• Addressing environmental problems such as air pollution and unsafe drinking water, which impact health worldwide.

Modern Public Health

Public health in the 21st century takes a comprehensive approach. It combines science, policy, and social strategies to improve wellbeing for all. Modern challenges, such as climate change, mental health, and inequality, are now part of public health discussions.

Recent focus areas include:

• Responding to pandemics like COVID-19 by implementing public health measures, testing, and vaccination campaigns.
• Tackling health inequalities by addressing root causes such as poverty, poor housing, and education gaps.
• Using technology like data tracking to monitor disease outbreaks or improve access to healthcare.

The History of Public Health in the UK

The UK had a leading role in developing public health systems. From Edwin Chadwick’s sanitary reforms to the creation of the NHS, the country has a history of prioritising health improvement for its citizens.

Key public health milestones in the UK:

• Vaccination Act (1853): Made smallpox vaccination compulsory.
• NHS creation (1948): Ensured free healthcare as a right for every citizen.
• Smoking Ban (2007): Reduced tobacco-related illnesses by banning indoor smoking in public spaces.

Public health today continues to adapt to new challenges like obesity, air pollution, antibiotic resistance, and increasing demands on healthcare systems.

Why Study the History of Public Health?

Understanding the history of public health helps us learn from past successes and mistakes. It shows us the importance of early interventions, collective action, and long-term planning.

Key lessons include:

• Investing in preventive measures can save lives and reduce healthcare costs.
• Collaborative approaches between governments, local communities, and healthcare providers are necessary for success.
• Education helps individuals take responsibility for their health while society addresses broader challenges.

In this unit, when summarising the history of public health, focus on how historical efforts influence our current understanding of health and disease prevention. Past public health movements have shaped everything we know about protecting populations.